No description available.

No description available.

Globally, thalassaemia is considered the most common inherited single-gene disorder. It is more prevalent in the Mediterranean Region (Tadmouri, et al., 2003). For instance, in Jordan there were about 1500 thalassaemia patients with a prevalence rate of about 4 to 6% of Beta Thalassemia Major (BTM) (Hamamy, et al., 2007). Jordan was chosen as the geographical location for this research because of a lack of studies of genetic haematological disorders in the country (Hamamy, et al., 2007). The study aimed to explore and understand parents’ experiences of caring for their children diagnosed with BTM, as well as to identify their coping strategies. In order to achieve this aim, grounded theory was adopted in this study. Data were collected through ‘face-to-face’ semi-structured interviews with forty Jordanian participants: 20 fathers and 20 mothers of children with BTM diagnosed for more than one year at three hospitals in Amman, Irbid and Al-Zarqa. Field notes and memos were also used in data collection. Given the lack of qualitative research in this area the findings of this study provide new, profound insights and better understanding of parents’ experiences and coping strategies caring for their child with BTM. The findings explored the positive and negative sides of parents’ experiences, and how they coped in terms of their knowledge and feelings. They also showed that parents’ experiences were negatively impacted by their lack of knowledge about BTM, and by restrictions from their social and cultural norms. Jordanian parents caring for children with BTM experienced an emotional burden and grief. However, parents were satisfied with the health care services that their children received, and with their role as carers. In addition, strategies such as faith and social support were also found to help parents to cope. Exploring parents’ experiences and coping strategies can assist nurses, health care professionals and stakeholders in recognising and identifying the gaps in parents’ knowledge and needs. Furthermore, this study could assist health care professionals to have better understanding of parents’ emotional and psychological status, to develop new perspectives towards parents of children with BTM and could therefore assist them to deliver quality care to the patients with BTM and their families. This study may also help to raise community awareness of BTM and other haematological genetic disorders by addressing the important role of socio-cultural norms and religion in identifying how parents experience and cope with their situation caring for children with BTM. This thesis recommends that health care professionals need to support and empower parents and provide them with the appropriate and effective options to make their own decisions and adapt to their children with BTM condition.

This study explores discourses around private three- and four-dimensional (3/4D) ultrasound scans in pregnancy, the experiences of women who have 3/4D scans and what impact these scans may have on pregnant women. A critical discourse analysis of scanning company websites was undertaken to explore the discourses, identities and genres set up on the websites. Longitudinal interviews exploring women’s experiences of 3/4D scans were analysed using interpretative phenomenological analysis. Case studies, using longitudinal questionnaire and interview data, were used to investigate the psychological impact of 3/4D scans on pregnant women. The critical discourse analysis revealed mixed discourses, identities and genres. While 3/4D scans are not overtly medical, they nevertheless contain medical aspects. They are promoted as enhancing bonding and reassurance. In the interview analysis, two superordinate themes emerged: ‘Getting to know the baby’ and ‘Experiences of pregnancy’. While the women’s physical and emotional experiences of pregnancy varied considerably, there were more convergences in the desire to ‘get to know’ the fetus and how women approached this. While routine and 3/4D scans played an important role, fetal movement also emerged as a significant factor. The case studies showed that the psychological impact was not consistent. Scans had no effect on fetal health locus of control, may have reduced anxiety about specific issues for some women and may have had a positive impact on some components of bonding for some women. It is not possible to state categorically that they reduce anxiety or increase bonding. The psychological impact of 3/4D scans appears to be individually mediated and depends on pregnancy experience and individual psychological differences, highlighting the significance of individual factors in both research and practice. Two opposing discourses portray 3/4D scans as either beneficial, by enhancing reassurance and bonding, or problematic, by undermining women’s embodied knowledge and experience and being potentially risky. This study suggests that neither of these two conflicting discourses are reflected in women’s experiences. The women in this study were not motivated primarily by bonding or reassurance when choosing 3/4D scans, but considered them a nice experience; on the other hand, the scans do not seem to have had a detrimental impact either. The interview analysis suggests that women acquire knowledge about the fetus through scans and fetal movement and combine these to make sense of the fetus. This study also provides evidence that the concept and measurement of bonding during pregnancy is problematic and that professional and academic perspectives are not necessarily reflected in women’s experiences.

Globalization is increasingly considered an important influence on the determinants of health. Globalization, for the purposes of this study, was defined as a process of greater integration within the world economy through movements of goods and services, capital, technology and (to a lesser extent) labour, which lead increasingly to economic decisions being influenced by global conditions.(1) Although there have been many conceptual and theoretical explorations of the globalization and health relationship, only a limited number of empirical studies have sought to link the processes of globalization to health effects in a specific context and/or for a particular population such as children. The objectives of this thesis were two-fold: to investigate primarily the economic pathways and related political pathways by which globalization influences the determinants of health and health outcomes in low-income children ages zero to five in a mid-sized Canadian city (Saskatoon, Saskatchewan); to identify and analyze the policy responses at various levels (national, provincial, and municipal) that address the effects of globalization on determinants of health such as household income and distribution, employment and education for parents, housing, and social programs.<p> This study was a case study that used mixed methods. The case in this research was Saskatoon, a mid-size city located in the Canadian province of Saskatchewan. The analytical framework used to guide this study was developed by Labonte and Torgerson.(2) Methods included: a demographic profile for the City of Saskatoon; an environmental scan of federal, provincial, and municipal policy that has direct relevance for child health; process tracing; semi-structured interviews with low-income parents of young children (n=26); and trend analysis of child health outcomes among children ages zero to five.<p> The current phase of globalization in Canada and Saskatchewan is inextricably linked with the implementation of neoliberal policies such as tax restructuring, trade liberalization, privatization, deregulation, and greater integration in the global economy. This phase of globalization contributed to changes in the determinants of health that affect children and their families in Saskatoon. For instance, globalization has involved retrenchment of the welfare state in Canada and Saskatchewan. As the welfare state diminished in size and responsibility, poverty tended to deepen among those that were already poor. The retrenchment of the welfare state also led to diminished program access. In addition, globalization has emphasized the restructuring of the labour market to be more competitive and flexible. A restructured labour market and reduced access to services and programs contributed to greater inequalities in income in Canada, Saskatchewan, and Saskatoon. Finally, globalization contributed to declining housing affordability in Canadas cities such as Saskatoon.<p> Trend analysis at the neighbourhood-level to determine the linkages between changes in the determinants of child health and changes in child health outcomes was inconclusive. Further research is required to determine if the disparities in the determinants of child health that have been exacerbated by the economic and political processes of globalization have contributed to increasing disparities in child health outcomes.<p> This study indicated that the economic and political processes of globalization influenced the determinants of health among young low-income children and their families in Saskatoon through a number of pathways, but this is not to suggest that globalization was the only phenomenon at work. Although it was very difficult to draw any conclusions regarding the globalization and health relationship with certainty, this study offered a logical and a multi-prong approach to examining the effects of globalization on childrens health and health determining conditions. Studies of this nature are important for contributing to our understanding of the complex structures that influence health and for building up the linkages between globalization and health on a case-by-case basis.

Globalization is increasingly considered an important influence on the determinants of health. Globalization, for the purposes of this study, was defined as a process of greater integration within the world economy through movements of goods and services, capital, technology and (to a lesser extent) labour, which lead increasingly to economic decisions being influenced by global conditions.(1) Although there have been many conceptual and theoretical explorations of the globalization and health relationship, only a limited number of empirical studies have sought to link the processes of globalization to health effects in a specific context and/or for a particular population such as children. The objectives of this thesis were two-fold: to investigate primarily the economic pathways and related political pathways by which globalization influences the determinants of health and health outcomes in low-income children ages zero to five in a mid-sized Canadian city (Saskatoon, Saskatchewan); to identify and analyze the policy responses at various levels (national, provincial, and municipal) that address the effects of globalization on determinants of health such as household income and distribution, employment and education for parents, housing, and social programs.<p> This study was a case study that used mixed methods. The case in this research was Saskatoon, a mid-size city located in the Canadian province of Saskatchewan. The analytical framework used to guide this study was developed by Labonte and Torgerson.(2) Methods included: a demographic profile for the City of Saskatoon; an environmental scan of federal, provincial, and municipal policy that has direct relevance for child health; process tracing; semi-structured interviews with low-income parents of young children (n=26); and trend analysis of child health outcomes among children ages zero to five.<p> The current phase of globalization in Canada and Saskatchewan is inextricably linked with the implementation of neoliberal policies such as tax restructuring, trade liberalization, privatization, deregulation, and greater integration in the global economy. This phase of globalization contributed to changes in the determinants of health that affect children and their families in Saskatoon. For instance, globalization has involved retrenchment of the welfare state in Canada and Saskatchewan. As the welfare state diminished in size and responsibility, poverty tended to deepen among those that were already poor. The retrenchment of the welfare state also led to diminished program access. In addition, globalization has emphasized the restructuring of the labour market to be more competitive and flexible. A restructured labour market and reduced access to services and programs contributed to greater inequalities in income in Canada, Saskatchewan, and Saskatoon. Finally, globalization contributed to declining housing affordability in Canadas cities such as Saskatoon.<p> Trend analysis at the neighbourhood-level to determine the linkages between changes in the determinants of child health and changes in child health outcomes was inconclusive. Further research is required to determine if the disparities in the determinants of child health that have been exacerbated by the economic and political processes of globalization have contributed to increasing disparities in child health outcomes.<p> This study indicated that the economic and political processes of globalization influenced the determinants of health among young low-income children and their families in Saskatoon through a number of pathways, but this is not to suggest that globalization was the only phenomenon at work. Although it was very difficult to draw any conclusions regarding the globalization and health relationship with certainty, this study offered a logical and a multi-prong approach to examining the effects of globalization on childrens health and health determining conditions. Studies of this nature are important for contributing to our understanding of the complex structures that influence health and for building up the linkages between globalization and health on a case-by-case basis.

Throughout the twentieth century there has been academic debate about the relationship between early life experience and adult health. This thesis examines the origins of that debate, its manifestation in different scientific fields of inquiry, and its recent re-emergence in epidemiological research. It shows how the changing nature of the debate was inextricably related to changes in the notion of adult health, the development of methods of empirical investigation, and the consequent availability of scientific evidence. The thesis therefore spans a number of disciplines and draws on the relevant knowledge from each. During the first forty years of this century the debate was policy-led. Adult health was assumed to depend on child health but empirical investigations of the link were limited. Research concentrated on early life factors, such as the behaviour of the mother, which were thought to influence morbidity and mortality in infancy and childhood. The focus of the academic debate was whether these factors were environmental or genetic in origin. This debate had important policy implications. Public acceptance of the significance of the early environment provided the rationale for the emerging infant and child health services. More recent interest in the influence of early life on adult health sprang from two different hypotheses about the basis of adult health, both of which focus on adult chronic disease. The first hypothesis puts forward the view that adult lifestyle is the main source of risk for chronic disease, and considers early life factors only to the extent that they are associated with the development of healthy and unhealthy lifestyles. The interdisciplinary, American dominated debate associated with this hypothesis is policy-led, and lacks a common conceptual model for understanding the risk processes that may be involved in the lifetime development of health related behaviour. In contrast the second hypothesis gives a causal and dominant role to environmental factors during critical periods of growth in utero and infancy which affect particular body systems, with long term consequences for adult chronic disease. This epidemiological research is science-led and dominated by one British investigator (Professor DJP Barker) and his research team who have developed the concept of 'environmental programming'. The academic debate associated with this hypothesis concerns the interpretation that is given to research findings which show associations between early life and adult chronic disease. Whereas for Barker they are evidence of a biological process occurring at the beginning of life, for others they reflect continuity of social deprivation throughout life. It is the relative influence of the intrauterine, childhood and adult environment which is in dispute. The thesis addresses these questions in respect of cardiovascular and respiratory disease by drawing on data from the Medical Research Council's National Survey of Health and Development, a unique prospective study of the health and development of over 5000 men and women followed up since their birth in March 1946. Evidence is presented which suggests that the effect of early life factors on adult blood pressure, lung function and overall health status is irrespective of later socioeconomic experiences, thus providing support for the environmental programming model. A second model, based on Rutter's concept of 'chains of risk' is put forward to explain the lifetime development of health related behaviour, and is used to account for the links between adult physical activity and early social, educational and individual characteristics which are found in data from the National Survey. In the recent debate there has been little engagement with the policy process, although Barker's new theories have attracted considerable public attention. The thesis draws on its historical reviews of epidemiological research and child health services to consider what effects the evidence presented may have on health and social policies for children in the 1990s.

Background: Anemia is a condition that can negatively impact the strength, productivity, and cognition of an individual. Underlying causes are often micronutrient deficiencies or infectious diseases. In South Asia, the prevalence of anemia in preschool children has been estimated to be as high as 47% and micronutrient deficiencies are common. Aim: To determine the prevalence of anemia and its association with socio-demographic factors and micronutrient deficiencies in 4.5-year old children in Matlab, Bangladesh. Methods: Cross-sectional study based on secondary data collected within a prenatal food and micronutrient supplementation trial. Biomarker analyses of hemoglobin, iron, folate and vitamin B12 were carried out, and the prevalence of anemia and micronutrient deficiencies was determined. Information on maternal socio-demographic characteristics was collected in a previous study within the trial. Multiple logistic regression was carried out to investigate associations. Results: In total, 1,354 children participated in the study. The prevalence of anemia was 8% and associations were found with maternal education and season of blood testing. Children of mothers with ≥ 6 years of formal education, and the children giving blood in season 2 (mid-June – mid-October) and season 3 (mid-October – mid-February) had reduced risks of anemia by ≥ 48%. Deficiencies of iron, folate, and vitamin B12 were rare and not associated with anemia. Conclusion A much lower prevalence of anemia than anticipated was found in children in Matlab, Bangladesh. One reason could be the long presence of The International Centre for Diarrheal Disease Research, Bangladesh, which carries out research and provides health care.

Children with serious illnesses experience life disruptions that are of consequence to long-term health and development. The spiritual is integral to health, yet many healthcare providers claim a lack of understanding and comfort with attending to spiritual issues in practice. This hermeneutic phenomenological inquiry explores spirituality as lived by children with cancer and cystic fibrosis and highlights the importance of spirituality in the provision of holistic child healthcare. Four children aged nine to fourteen from each illness group (six males and two females) were interviewed and asked to draw pictures, forming the primary data for interpretation. Conversations with family members were also included in the analysis as supplements to the primary data. Study findings offer insights into children’s lived experiences of the spiritual. They reveal unmet spiritual needs and unique ways of living the spiritual that often went unrecognized by adults. The experiences shared were profound and deeply meaningful, revealing hidden wondering and wisdom that defies contemporary views of how children understand and deal with the complexity of living with serious illness. Findings provide more nuanced understandings of the spiritual that allow for the voices and emotions of children to be heard, revealing a sense of struggle and the need to find meaning in illness with all its disruptions and demands on time and freedom. Findings also reveal the meanings in relationships that sustained children in their efforts to live well with illness. These findings provide possibilities for viewing child health differently—a view that includes the spiritual and its implications—that can lead to a more conscious awareness, wisdom, and sensitivity in practice. Findings offer ways of engaging children in conversations about illness meanings and the spiritual that recognize the complexity in language and the need for alternate strategies to mine the depths of experiences that are often hidden. Because the spiritual does not always wait for experts to arrive, findings are relevant to all healthcare providers and caregivers of ill children. Implications for interprofessional research, education, and practice are also explored, providing possibilities for seeing, exploring, and living the spiritual in our practices of caring for ill children.

No description available.